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Published on: September 12, 2019
Serum CA 125 measurements to identify patients with endometrial cancer who require lymphadenectomy
N P Koper1, L F Massuger, C M Thomas
1Department of Obstetrics and Gynecology, University Hospital Nijmegen, The Netherlands.
Background:
Most studies evaluating the role of serum CA 125 measurements in endometrial cancer report a positive correlation with prognostic factors. The present study investigates the role of serum CA 125 measurements as a preoperative aid in the decision whether lymphadenectomy or sampling should be part of the surgical procedure.
Patients And Methods:
We retrospectively studied clinical data of 98 patients with endometrial cancer (FIGO stage I to III), who had serum samples available for analysis of IMx CA 125. Clinical information was included in the analysis in the order in which it became available to the clinician. Patients were grouped retrospectively on the basis of histopathologically determined factors. Those with grade 3 tumors, and/or myometrial invasion > or = 1/2, and/or cervical involvement, and/or parametrial or adnexal tissue involvement, and/or blood vessel invasion, were retrospectively assigned to require lymphadenectomy or sampling (N = 60). All other patients were classified as not requiring such a procedure (N = 38).
Results:
Serum IMx CA 125 concentrations correlated with all factors included in the surgical FIG0 classification. The sensitivity to identify patients who would have required a lymphadenectomy or sampling on the basis of precurretage serum CA 125 measurements ranged between 17% (10/60) with cut-off of 35 U/ml, and 53% (32/60) with a 15 U/ml cut-off. Corresponding specificity to exclude patients for lymphadenectomy or sampling ranged from 95% (36/28) to 76% (29/38), respectively. After curettage, information regarding histological grade became available. Using only this information, 17 out of 60 patients who would have required a lymphadenectomy or sampling could be identified because of their grade 3 tumor. The combination of serum CA 125 and histological grade could identify between 37% (22/60) and 65% (39/60) of the patients who required a lymphadenectomy or sampling cut-offs again ranging from 35 to 15 U/ml.
Conclusions:
CA 125 serum levels may provide additional information in the preoperative assessment of endometrial cancer patients. More studies are needed to establish the appropriate cut-off level for serum CA 125 in this respect.
